Healthcare Provider Details

I. General information

NPI: 1083635247
Provider Name (Legal Business Name): COMMUNITY MRI SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE NE
JAMESTOWN ND
58401-3373
US

IV. Provider business mailing address

3223 32ND AVENUE S SUITE 201
FARGO ND
58103-6278
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-5800
  • Fax: 701-253-5801
Mailing address:
  • Phone: 701-297-0305
  • Fax: 701-235-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J PAULSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 701-297-0305